The health care needs and challenges of Seattle’s homeless population

As local media outlets participate in the #Seahomeless day of coverage, State of Reform decided to elevate the health care needs of our homeless population, and the barriers they experience when trying to accessing care.

The Healthcare for the Homeless Network (HCHN) is part of Seattle Public Health Department. In its Community Needs Assessment 2016-17 report, HCHN features data from its patient population of over 20,000 individuals, performance measurement data from over 200 providers, and reports from the local Homeless Management Information System.

HCHN also includes information gathered from Listening Sessions with 101 individuals who are currently homeless or were homeless in the past year and from surveys and interviews with HCHN providers.

Current health care needs for people experiencing homelessness are grouped into five categories: basic needs, chronic disease management, chronic pain, dental care, and vision care.

Comments from the Listening Sessions revealed the challenges of living with a chronic condition, accessing care, and remaining healthy:

“With diabetes, you try to figure out how to test your blood sugar daily and store everything.”

“There is something wrong with my stent (heart disease) but I’m not going back in for help. There is nowhere safe or clean to come back to. Disease and stuff spreads like wildfire in shelters.”

“I never get enough sleep. Been woken up 6 to 7 times in a night. I’m always dealing with issues. Constant pain from sleeping all curled up.”

Individuals experiencing homeless often experience three phases of delays in accessing and utilizing care.

Individuals explained the challenges of finding accurate resource lists, having gaps in care or documentation, and being turned feeling unwelcomed:

“You all need to keep the resource lists simple and up to date. It’s easy to give up after all the run around and dead ends.”

“You move around a lot being homeless, lose paperwork and things, and you have to get care at a new clinic. They may not cover or offer the same things. You end up with a gap in care.”

“One experience of being turned away was enough. You can tell when people are judging you, just want you to go away.”

Providers described the health care needs they see in the homeless population:

  • Severity of medical needs that accumulate the longer individuals and families remain homeless in King County.
  • Sheer level of co-occurring behavioral health needs, especially opioid dependence and untreated mental health conditions.
  • Drug resistance for multiple conditions and challenges in prescribing treatments without full health history.
  • Growing elderly homeless population who present with early onset of geriatric conditions and cognitive impairments.
  • Assuring access to prenatal care, reproductive health, family planning, and early intervention services.

In order to improve health outcomes and improve access to care, providers would like to see partnerships, policy and system change that lead to:

  • Fewer patients being lost to follow-up because of fragmented information systems.
  • Strategic use of bed space and facilities in all physical and behavioral health settings.
  • Expanded low barrier substance use services, including Medication-Assisted Treatment.
  • Efficiencies in regulatory and reporting requirements for payment and documentation.
  • Reductions of the number of homeless individuals cycling through criminal justice systems.
  • Further integration of public health, health care, and housing services that lead to safe, stable, and secure housing options with clear referral processes based on medical need.